Unilateral pallidal deep brain stimulation in a patient with cervical dystonia and tremor

Case report

Cristina V. Torres M.D. 1 , Elena Moro M.D., Ph.D. 2 , Jonathan O. Dostrovsky Ph.D. 3 , William D. Hutchison Ph.D. 4 , Yu-Yan W. Poon R.N. 2 , and Mojgan Hodaie M.D., M.Sc., F.R.C.S.C. 1
View More View Less
  • 1 Division of Neurosurgery, Department of Surgery;
  • 2 Movement Disorders Center, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network; and
  • 3 Departments of Physiology and
  • 4 Surgery, University of Toronto and Toronto Western Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Bilateral deep brain stimulation of the globus pallidus pars interna (GPi) is the favored neuromodulation procedure in cases of cervical dystonia. The authors report on a case of unilateral GPi implantation that resulted in sustained benefit with marked improvement in pain and dystonia.

Abbreviations used in this paper: BTX = botulinum toxin; CD = cervical dystonia; DBS = deep brain stimulation; GPi = globus pallidus internus; SCM = sternocleidomastoid; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Mojgan Hodaie, M.D., M.Sc., F.R.C.S.C., Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, 4W-443, Toronto, Ontario M5T 2S8, Canada. email: mojgan.hodaie@uhn.on.ca.

Please include this information when citing this paper: published online May 28, 2010; DOI: 10.3171/2010.4.JNS091722.

  • 1

    Albanese A, , Barnes MP, , Bhatia KP, , Fernandez-Alvarez E, , Filippini G, & Gasser T, : A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol 13:433444, 2006

    • Search Google Scholar
    • Export Citation
  • 2

    Bereznai B, , Steude U, , Seelos K, & Bötzel K: Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 17:138144, 2002

    • Search Google Scholar
    • Export Citation
  • 3

    Bittar RG, , Yianni J, , Wang S, , Liu X, , Nandi D, & Joint C, : Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 12:1216, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Bronstein JM, , DeSalles A, & DeLong MR: Stereotactic pallidotomy in the treatment of Parkinson disease: an expert opinion. Arch Neurol 56:10641069, 1999

    • Search Google Scholar
    • Export Citation
  • 5

    Cersosimo MG, , Raina GB, , Piedimonte F, , Antico J, , Graff P, & Micheli FE: Pallidal surgery for the treatment of primary generalized dystonia: long-term follow-up. Clin Neurol Neurosurg 110:145150, 2008

    • Search Google Scholar
    • Export Citation
  • 6

    Chang JW, , Choi JY, , Lee BW, , Kang UJ, & Chung SS: Unilateral globus pallidus internus stimulation improves delayed onset post-traumatic cervical dystonia with an ipsilateral focal basal ganglia lesion. J Neurol Neurosurg Psychiatry 73:588590, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Collins KL, , Lehmann EM, & Patil PG: Deep brain stimulation for movement disorders. Neurobiol Dis [epub ahead of print] 2009

  • 8

    DeLong MR, & Wichmann T: Circuits and circuit disorders of the basal ganglia. Arch Neurol 64:2024, 2007

  • 9

    Escamilla-Sevilla F, , Mínguez-Castellanos A, , Arjona-Morón V, , Martín-Linares JM, , Sánchez-Alvarez JC, & Ortega-Morenoa A, : Unilateral pallidal stimulation for segmental cervical and truncal dystonia: which side?. Mov Disord 17:13831385, 2002

    • Search Google Scholar
    • Export Citation
  • 10

    Foote KD, , Sanchez JC, & Okun MS: Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery 56:E415, 2005

    • Search Google Scholar
    • Export Citation
  • 11

    Ford B: Pallidotomy for generalized dystonia. Adv Neurol 94:287299, 2004

  • 12

    Gross RE: What happened to posteroventral pallidotomy for Parkinson's disease and dystonia?. Neurotherapeutics 5:281293, 2008

  • 13

    Hung SW, , Hamani C, , Lozano AM, , Poon YY, , Piboolnurak P, & Miyasaki JM, : Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 68:457459, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Intemann PM, , Masterman D, , Subramanian I, , DeSalles A, , Behnke E, & Frysinger R, : Staged bilateral pallidotomy for treatment of Parkinson disease. J Neurosurg 94:437444, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Işlekel S, , Zileli M, & Zileli B: Unilateral pallidal stimulation in cervical dystonia. Stereotact Funct Neurosurg 72:248252, 1999

  • 16

    Krause M, , Fogel W, , Kloss M, , Rasche D, , Volkmann J, & Tronnier V: Pallidal stimulation for dystonia. Neurosurgery 55:13611370, 2004

  • 17

    Levy R, , Dostrovsky JO, , Lang AE, , Sime E, , Hutchison WD, & Lozano AM: Effects of apomorphine on subthalamic nucleus and globus pallidus internus neurons in patients with Parkinson's disease. J Neurophysiol 86:249260, 2001

    • Search Google Scholar
    • Export Citation
  • 18

    Lippitz BE, , Mindus P, , Meyerson BA, , Kihlström L, & Lindquist C: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery 44:452460, 1999

    • Search Google Scholar
    • Export Citation
  • 19

    Loher TJ, , Pohle T, & Krauss JK: Functional stereotactic surgery for treatment of cervical dystonia: review of the experience from the lesional era. Stereotact Funct Neurosurg 82:113, 2004

    • Search Google Scholar
    • Export Citation
  • 20

    Lozano AM, & Abosch A: Pallidal stimulation for dystonia. Adv Neurol 94:301308, 2004

  • 21

    Lozano AM, & Eltahawy H: How does DBS work?. Suppl Clin Neurophysiol 57:733736, 2004

  • 22

    Lozano AM, & Hutchison WD: Microelectrode recordings in the pallidum. Mov Disord 17:Suppl 3 S150S154, 2002

  • 23

    Moro E, , Piboolnurak P, , Arenovich T, , Hung SW, , Poon YY, & Lozano AM: Pallidal stimulation in cervical dystonia: clinical implications of acute changes in stimulation parameters. Eur J Neurol 16:506512, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Nakamura K, , Christine CW, , Starr PA, & Marks WJ Jr: Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson's disease. Mov Disord 22:619626, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Odergren T, , Rimpiläinen I, & Borg J: Sternocleidomastoid muscle responses to transcranial magnetic stimulation in patients with cervical dystonia. Electroencephalogr Clin Neurophysiol 105:4452, 1997

    • Search Google Scholar
    • Export Citation
  • 26

    Ondo W, , Almaguer M, , Jankovic J, & Simpson RK: Thalamic deep brain stimulation: comparison between unilateral and bilateral placement. Arch Neurol 58:218222, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Ondo WG, , Desaloms JM, , Jankovic J, & Grossman RG: Pallidotomy for generalized dystonia. Mov Disord 13:693698, 1998

  • 28

    Ostrem JL, & Starr PA: Treatment of dystonia with deep brain stimulation. Neurotherapeutics 5:320330, 2008

  • 29

    Tanei T, , Kajita Y, , Kaneoke Y, , Takebayashi S, , Nakatsubo D, & Wakabayashi T: Staged bilateral deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease. Acta Neurochir (Wien) 151:589594, 2009

    • Search Google Scholar
    • Export Citation
  • 30

    Tang JK, , Moro E, , Mahant N, , Hutchison WD, , Lang AE, & Lozano AM, : Neuronal firing rates and patterns in the globus pallidus internus of patients with cervical dystonia differ from those with Parkinson's disease. J Neurophysiol 98:720729, 2007

    • Search Google Scholar
    • Export Citation
  • 31

    Toda H, , Hamani C, & Lozano A: Deep brain stimulation in the treatment of dyskinesia and dystonia. Neurosurg Focus 17:1 E2, 2004

  • 32

    Uitti RJ, , Wharen RE, , Duffy JR, , Lucas JA, , Schneider SL, & Rippeth JD, : Unilateral pallidotomy for Parkinson's disease: speech, motor, and neuropsychological outcome measurements. Parkinsonism Relat Disord 6:133143, 2000

    • Search Google Scholar
    • Export Citation
  • 33

    Yu H, & Neimat JS: The treatment of movement disorders by deep brain stimulation. Neurotherapeutics 5:2636, 2008

  • 34

    Zabek M, , Sobstyl M, , Koziara H, & Dzierzecki S: Deep brain stimulation of the right nucleus accumbens in a patient with Tourette syndrome. Case report. Neurol Neurochir Pol 42:554559, 2008

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 487 86 3
Full Text Views 147 7 0
PDF Downloads 164 5 0
EPUB Downloads 0 0 0